<?php
require("include/db.php");
require("include/head.php");
?>
<div id="siSignupDiv">
<H1>Create Your UwannaMail member Account</H1>
<P>It's free and easy. Just fill out the account info below. (All fields required).</P>
	<form id="form1" name="form1" method="post" action="membersignupsucces.php">
	<input type="hidden" value="member" name="type">
  <table width="100%" border="0">
    <tr>
      <td class=loginFormLabel>User name:</td>
      <td class=formFieldSmall>
          <input type="text" name="username" />
      </td>
    </tr>
    <tr>
      <td class=loginFormLabel>Email Address:</td>
      <td class=formFieldSmall>
          <input type="text" name="email" />
      </td>
    </tr>
    <tr>
      <td class=loginFormLabel>Password:</td>
      <td class=formFieldSmall><input type="password" name="password" /></td>
    </tr>
    <tr>
      <td class=loginFormLabel>Confirm Password:</td>
      <td class=formFieldSmall><input type="password" name="confirmpassword" /></td>
    </tr>
    <tr>
      <td class=loginFormLabel>Birth date:</td>
      <td class=formFieldSmall>
      	<SELECT tabIndex=13 name=birthday_mon> <OPTION 
        value=0 selected>---</OPTION> <OPTION value=1>January</OPTION> <OPTION 
        value=2>February</OPTION> <OPTION value=3>March</OPTION> <OPTION 
        value=4>April</OPTION> <OPTION value=5>May</OPTION> <OPTION 
        value=6>June</OPTION> <OPTION value=7>July</OPTION> <OPTION 
        value=8>August</OPTION> <OPTION value=9>September</OPTION> <OPTION 
        value=10>October</OPTION> <OPTION value=11>November</OPTION> <OPTION 
        value=12>December</OPTION></SELECT> <SELECT tabIndex=14 name=birthday_day> 
        <OPTION value=0 selected>---</OPTION> <OPTION value=1>1</OPTION> <OPTION 
        value=2>2</OPTION> <OPTION value=3>3</OPTION> <OPTION value=4>4</OPTION> 
        <OPTION value=5>5</OPTION> <OPTION value=6>6</OPTION> <OPTION 
        value=7>7</OPTION> <OPTION value=8>8</OPTION> <OPTION value=9>9</OPTION> 
        <OPTION value=10>10</OPTION> <OPTION value=11>11</OPTION> <OPTION 
        value=12>12</OPTION> <OPTION value=13>13</OPTION> <OPTION 
        value=14>14</OPTION> <OPTION value=15>15</OPTION> <OPTION 
        value=16>16</OPTION> <OPTION value=17>17</OPTION> <OPTION 
        value=18>18</OPTION> <OPTION value=19>19</OPTION> <OPTION 
        value=20>20</OPTION> <OPTION value=21>21</OPTION> <OPTION 
        value=22>22</OPTION> <OPTION value=23>23</OPTION> <OPTION 
        value=24>24</OPTION> <OPTION value=25>25</OPTION> <OPTION 
        value=26>26</OPTION> <OPTION value=27>27</OPTION> <OPTION 
        value=28>28</OPTION> <OPTION value=29>29</OPTION> <OPTION 
        value=30>30</OPTION> <OPTION value=31>31</OPTION></SELECT>
        	<SELECT  tabIndex=15 name=birthday_yr>
        		<OPTION value=0 selected>---</OPTION> 
        		<?php
        		$today = getdate();
        		$year = $today[year];
        		for ($i=0;$i<=80;$i++)
        		{
        			print_r("<option value=".($year-$i).">".($year-$i)."</option>\r\n");
        		}
        		?>
        		</SELECT></td>
    </tr>
    <tr>
      <td class=loginFormLabel>City:</td>
      <td class=formFieldSmall><input type="text" name="city" /></td>
    </tr>
    <tr>
      <td class=loginFormLabel>Gender:</td>
      <td class=formFieldSmall>
      	<INPUT tabIndex=11 type=radio value=Male    name="gender"> Male &nbsp; 
      	<INPUT tabIndex=12 type=radio value=Female  name="gender"> Female</td>
    </tr>
    <tr>
      <td class=loginFormLabel></td>
      <td class=formFieldSmall>&nbsp;</td>
    </tr>
    <tr>
      <td class=loginFormLabel colspan="2">
        <input type="submit" value="Sign Up"/>
      </td>
    </tr>
  </table>
 </form>
</div>
<?php
include "include/foot.php";
?>